FY2015 Hospital Inpatient Discharge Database Documentation Guide
Document Revision History
Date / Version Number / Writer / Requested by: / Key Changes:July 2016 / Release Copy - V1.0 / K. Walsh / C. Herrera
August 2016 / Release Copy - V1.1 / K. Walsh / C. Herrera / 1) Age - clarification on Age calculation method
2) Added detail in Data Delivery for File format detail and linkage description
3) Updated Zip Code content
4) Added Grouper content with year over year table reference
Contents
Executive Summary
Part A. Data Collection
Verification Report Process
Part B: Core DataElements
Data Elements Available for LDS and Government Users
Condition Present on Admission (POA) Indicators
Diagnosisand Procedure Codes
Emergency Department (ED) Flag
Ethnicity
ExternalCauseofInjury Code (E-Code)
HispanicIndicator
HomelessIndicator
Leave of Absence (LOA) Days
Outpatient Observation Stay Flag
Organization Identifiers (ORG ID)
OtherCaregiver
Patient Status
Zip Code
Payer Codes
Race
Revenue Codes
Source of Admission
Data Available for Government Users Only
Do Not Resuscitate(DNR)Status
Mother’sMedicalRecordNumber
Other Ethnicity
Other Race
Part C: Derived Data
FY15 HIDD Groupers
HIDD Groupers Across Years Table
AllPatientRefinedGrouper(3M™ APR-DRGs 20.0, 26.1, and 30.0)
CMS-DRG 32.0
Severity of Illness and Risk of Mortality
Major Diagnostic Category (MDC)
CalculatedFields Available For LDS and Government Users
Age LDS (formerly Patient Age)
DaysBetween Stays
Length ofStay (LOS)
PreoperativeDays
Unique Health Information Number (UHIN)
Mother’s UHIN
UHIN SequenceNumber
Unique Physician Number(UPN)
Part D: DataLimitations
Race and Ethnicity Data
Historical DataElements
SUPPLEMENT 1. Applying For and Using CHIA Data
Applying for CHIA Data
How to Apply for the Data
Securing CHIA Data Prior to Use
Data Delivery
Hardware Requirements:
CD Contents:
File Formats Available
Hospital Location and ORG IDs
Executive Summary
The FY2015 Hospital Inpatient Discharge Database Guide provides general information about CHIA’s most recent inpatient data holdings.
Each quarter, Massachusetts acute care hospitals provide CHIA with inpatient information that CHIA transforms into annual hospital inpatient discharge databases (HIDDs). This data is provided for all hospital patients, regardless of residencyor payer type. The FY2015 HIDD includes all reported inpatient discharges that occurred between October 1, 2014 and September 30, 2015. Acute care hospitalsreported to CHIA the occurrence of 796,835 inpatient dischargesfor FY2015.
The information in this guide is limited to high level data notes. The document describes how the data was collected, a description of selected data elements, derived data elements, and data limitations. As always, CHIAstronglysuggeststhatusersperformsomequalitativechecksof thedata priortodrawingconclusionsaboutthat data.
New in FY 2015
CHIA has created new, CHIA Limited Data Set (LDS) users to allow more flexibility in data use. Information about the application process is available in SUPPLEMENT 1. Applying For and Using CHIA Data.
CHIA will report diagnoses and procedure codes from Providers, who are using the codes supplied via the International Classification of Diseases, Ninth Revision, and Clinical Modification (ICD-9-CM). While CHIA has lifted the limit on the number of diagnosis and procedure codes in the FY2015 release, there are noICD-10-CM codes in this dataset.
Part A. Data Collection
Acute hospitals in Massachusetts are required to submit discharge data to CHIA under 957 CMR 8.00 - APCD and Case Mix Data Submissionand Regulation 957 CMR 5.00: Health Care Claims, Case Mix and Charge Data Release Procedures. Researchers can access HIDD regulations by visiting CHIA’s web site [ or by faxing a request to CHIA at 617-727-7662.
957 CMR 8.00 - APCD and Case Mix Data Submissionrequires acute care hospitalstosubmitdischarge datatoCHIA75daysaftereachquarter.Thequarterly reporting intervals for the 2015 HIDD areasfollows:
Quarter1: October1,2014- December31, 2014
Quarter2:January1,2015–March31,2015
Quarter3: April 1, 2015–June30, 2015
Quarter4: July1, 2015–September 30, 2015
CHIA reviews each hospital’s quarterlydatafor compliancewith 957 CMR 8.00 - APCD and Case Mix Data Submissionusing a one percent errorrate. Theone percenterrorrateisbasedupon thepresenceofone or moreerrorsper discharge for the hospital’s quarterly submission. CHIA checks for valid codes,correctformatting,and presenceoftherequireddata elements.If onepercentormoreof thedischargesarerejected, CHIA rejects theentiresubmission.
Each hospitalreceivesaquarterly errorreportdisplaying invalid dischargeinformation. Quarterly datathatdoesnot meettheonepercentcompliancestandardmustberesubmitted by the reportinghospitaluntilthestandard ismet.
Verification Report Process
Annually CHIA sends each hospital a report on their discharge data to maintain and improve the qualityof their submissions. The Verification Report process givesthe hospitals theopportunitytoreviewthedatatheyhaveprovided to CHIA and affirmdataaccuracy.
CHIA produces hospital specific Verification Reportsaftereachhospitalsuccessfullysubmitsfourquartersofdata.CHIA asks each hospital to reviewandverifythe datacontainedwithin thereport.Each Verification Reporthasaseriesoffrequencytables for selected dataelements that include, but are not limited to, thenumberofdischarges per month and breakouts by admission type, admission source, race, and disposition.
Hospitalsmustaffirmthatreported data isaccurate oridentifyanydiscrepancies.Hospitalscertifytheaccuracyoftheirdatabycompleting aVerificationReport Responseform.CHIA accepts two response types from hospitals:
A: Ahospitalindicatesitsagreementthat thedataappearingon the Verification Reportisaccurateand thatitrepresentsthehospital’scasemixprofile.
B: A hospitalindicatesthatthedataonthereportis accurateexcept forthediscrepanciesnoted. Ifanydatadiscrepanciesexist,CHIArequeststhat hospitalsprovidewritten explanationsofthediscrepancies.
Users interested in the FY2015HIDD Verification Reports should contact CHIA at . Please indicate the fiscal year of the Verification Report, the dataset name, and if you need information for a specific hospital or set of hospitals.
Part B: CoreDataElements
The purpose of the following section is to provide the user with an explanation of some of data, and to give a sense of their reliability. For more information about specific data elements, hospital reporting thresholds, or other questions about the data, please contact CHIA by .
Data Elements Available for LDS and Government Users
Condition Present on Admission (POA) Indicators
These flags indicate the onset of a diagnosisprecededorfollowed admission. There is a POA indicator for everydiagnosisand E-code field.
Diagnosisand Procedure Codes
In FY2015, CHIA removed the limit onthe number of diagnosis and procedure codes submitted and released. In FY2015, 32% of discharges have greater than 15 diagnoses. Discharges reached a maximum of 107 diagnosis codes, and a maximum of 68 procedure codes.
Emergency Department (ED) Flag
The ED Flag is used to identify patients admitted from thehospital’semergencydepartment and with previous ED utilization.
Ethnicity
BeginningOctober1, 2006,HIDD includes two main fieldstoreportEthnicity: Ethnicity 1 andEthnicity2. The ethnicity codes are based on the CDC race/ethnicity code [
ExternalCauseofInjury Code (E-Code)
This data elementdescribes theprincipalexternalcauseofinjuries, poisonings,and adverseeffects using ICD-9 codes. In addition to the dedicated E-Code field, hospitals record additional E-Codes in the associated diagnosis fields for conditions having multiple causes.
HispanicIndicator
A flag for patients of Cuban, Mexican, Puerto Rican or Central American or other Spanish or other Spanish culture or origin regardless of race.
HomelessIndicator
This flag indicatesthat thepatient washomeless at the time of discharge.
Leave of Absence (LOA) Days
Hospitals report leave of absence days when used by the patient. These are the number of days of a patient's absence with physician approval during a hospital stay without formal discharge and readmission to the facility. These days cannot be greater than the total length of stay.CHIA cannot verifytheuseof thesedaysiftheyarenotreported,norcanCHIAverifythenumberreportedwhenahospital providestheinformation. Thevalidity ofthisdata elementreliessolely on the accuracyofagivenhospital’sreportingpractices.
Outpatient Observation Stay Flag
This flags indicatesthat thepatient wasadmitted from thehospital’soutpatient observation department or had prior outpatient utilization.
Organization Identifiers (ORG ID)
CHIA FY2015 contains four organization identifier fields. These fields are a CHIA assigned unique code for each Massachusetts hospital:
- Massachusetts Filer Organization ID (IdOrgFiler) – The Organization ID for the hospital that submitted the inpatient discharge data to CHIA.
- Massachusetts Site Organization ID (IdOrgSite) - The Organization ID for the site where the patient received inpatient care.
- Massachusetts Hospital Organization ID (IdOrgHosp) - The Organization ID for the main hospital affiliation. For example 3108 (Cambridge Health Alliance) is the IdOrgHosp for the IdOrgSite 142 (Whidden Hospital).
- Massachusetts Transfer Hospital Organization ID (IdOrgTransfer) – is the Organization ID for the facility from which a patient is transferred. If the patient is transferred from outside of Massachusetts, the IdOrgTransfer will be 9999999.
OtherCaregiver
This data element indicates the type of primarycaregiverresponsibleforthepatient’scareotherthantheattending physician, operatingroom physician,ornursemidwifeasspecifiedin theRegulation.Othercaregiver codes includeresident,intern,nurse practitioner,and physician’sassistant.
Patient Status
This field identifies the disposition and destination of the patient when discharged from the hospital.
Table 1.Patient Status Codes
Patient Disposition Codes / Discharge Circumstances and Patient Destination1 / Discharged/transferred to home or self-care (routine discharge)
2 / Discharged/transferred to another short-term general hospital for inpatient care
3 / Discharged, transferred to Skilled Nursing Facility (SNF)
4 / Discharged/transferred to an Intermediate Care Facility (ICF)
5 / Discharged/transferred to a Designated cancer Center or Children’s Hospital
6 / Discharged/transferred to home under care of organized home health service organization
7 / Left against medical advice
8 / Discharged/transferred to home under care of a Home IV Drug Therapy Provider
12 / Discharge Other
13 / Discharge/transfer to rehab hospital
14 / Discharge/transfer to rest home
15 / Discharge to Shelter
20 / Expired (or did not recover - Christian Science Patient)
50 / Discharged to Hospice - Home
51 / Discharged to Hospice Medical Facility
43 / Discharged/transferred to federal healthcare facility
61 / Discharged/transferred within this institution to a hospital-based Medicare-approved swing bed
62 / Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital.
63 / Discharge/transfer to a Medicare certified long term care hospital.
64 / Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare
65 / Discharged/transferred to psychiatric hospital or psychiatric distinct part unit of a hospital.
66 / Discharged/transferred to a Critical Access Hospital (CAH).
69 / Discharged/transferred to a designated disaster alternative care site
70 / Discharged/transferred to another type of health care institution not defined elsewhere in code list.
81 / Discharged to home or self-care with a planned acute care hospital readmission
82 / Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission
83 / Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission
84 / Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission
85 / Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission
86 / Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission
87 / Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission
88 / Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission
89 / Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission
90 / Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission
91 / Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission
92 / Discharged/transferred to nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission
93 / Discharged/transferred to a psychiatric hospital/distinct part unit of a hospital with a planned acute care hospital inpatient readmission
94 / Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission
95 / Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission
A small percentage of records are missing the zero used to pad codes 10 thru 18. For example, the entire code might consist of the digit 7, rather than 07.
Zip Code
IfunknownorifthepatientcountryisnottheUnited States, zip codesmustbe set to zeros (0s). The Limited Data Set supports selection of 3-character Zip Code or 5-character Zip Code for approval by CHIA, in relation to other data elements that are considerate of patient privacy.Any additional questions can be addressed by contacting CHIA at .
Payer Codes
There are four Payer Codes: Payer Code 1, Payer Code 2, Primary Payer Type, and Secondary Payer Type. The Payer codes indicate the source of the specific health care coverage plan, such as Harvard Pilgrim Health Plan or Tufts Associated Health Plan. The payer typesare the general payer category, such as HMO, Commercial, or Workers’ Compensation.
Race
Prior toOctober1,2006,therewasasinglefield toreportpatientrace. Beginning
October1, 2006,thereweretwo mainfieldstoreportrace: Race1,Race2,and OtherRace.
Beginning in FY2007,theCHIA’s predecessor agency adopted federal Office of Management and Budget standardrace and ethnicityvalues that were consistent with CDCstandards.[1]
Table 2.Race Codes
Race Codes (As of FY 2007) / DescriptionR1 / American Indian /Alaska Native
R2 / Asian
R3 / Black/African American
R4 / Native Hawaiian or Other Pacific Islander
R5 / White
R9 / Other Race
UNKNOW / Unknown/not specified
Users seeking to compare pre-FY2000 HIDD to data submitted between FY2000 – FY2006, will need to standardize race codes usingthe translation table below.
Table 3.Race Codes prior to FY2006
RaceCode / FY2000 –FY2006 / Pre-20001 / White / White
2 / Black / Black
3 / Asian / Other
4 / Hispanic / Unknown
5 / American Indian / American Indian
6 / Other / Asian
9 / Unknown / Hispanic
Revenue Codes
Revenue Codes coincide with the current UB-04 Revenue Codes, which became effective on March 1, 2007.
Source of Admission
The two sources of admission codes indicate the source of referring or transferring the patient to inpatient status in the hospital. Primary Source of Admission is the originating, referring, or transferring facility or primary referral source causing the patient to enter the hospital. SecondarySource ofAdmission accommodates patients’ two sources of admission (for example, patients who transferred twice prior to admission).
In January1994,threenewsources ofadmission wereadded:ambulatorysurgery,observation,and extramural birth (fornewborns).
Thecodeswerefurtherexpanded effectiveOctober1, 1997,tobetterdefineeach admission source.Physician referralwasfurtherclarified as “DirectPhysicianReferral”versuscalling ahealthplan foran HMOReferralor DirectHealthPlanReferral.”“ClinicReferral”wasseparated into “Within HospitalClinic Referral”and“Outside HospitalClinic Referral.”And “EmergencyRoom Transfer” wasfurtherdelineatedtoinclude“OutsideHospital Emergency RoomTransfers”and“Walk-In/Self- Referrals.”
Itisimportant to notethatthecode“TransferfromWithinHospitalEmergencyRoom”isintendedto be used asaSecondarySourceofAdmissiononly,exceptin caseswherethehospitalisunabletodeterminethe originating orprimarysource ofadmission.
Data Available for Government Users Only
Do Not Resuscitate(DNR)Status
This element indicates that thepatienthas aphysicianordernottoresuscitateor thepatienthad astatusof receiving palliativecareonly.
Mother’sMedicalRecordNumber
Themedicalrecord numberassigned within thehospitaltothe newborn’smother. Thismedicalrecord number distinguishesthepatient’smotherandthepatient’smother’s hospitalrecord(s)fromallothersin that institution.
Other Ethnicity
OtherEthnicityis afreetextfieldforreporting anyadditionalethnicities available only to Government Users.
Other Race
Other Race is an open text field for reporting additional races whenRace 1 or Race 2 equals “R9”, or “Other Race”.
Part C: Derived Data
CHIA produces from the discharge data a number of derived elements and enhancements. These include Groupers and Calculated Fields.
FY15 HIDD Groupers
For researcher convenience, CHIA performs data grouping using 3M™ APR-DRG groupers. For the FY2015 HIDD, CHIA calculatedthree All Patient Refined (APR) Diagnostic Related Groups (DRGs) and one Medicare (CMS) Diagnosis Related Grouper (Table 2). For each APR-DRG type, CHIA also calculated the Major Diagnosis Category, and two subclasses (Severity ofIllness and RiskofMortality) for each discharge.
Table 4.FY2015 HIDD Groupers
Grouper / Available / Major Diagnostic Category Field / Severity of Illness Field / Risk of Mortality FieldAPR-DRG 20.0 / FY2007-FY2015 / Yes / Yes / Yes
APR–DRG 26.1 / FY2009-FY2015 / Yes / Yes / Yes
APR–DRG 30.0 / FY2009-FY2015 / Yes / Yes / Yes
CMS-DRG 32.0 / FY2015 / Yes / n/a / n/a
HIDD Groupers Across Years Table
HIDD / AP-DRG (APD) / APR-DRG Version 12 / VHAF - DRG / CMS - DRGFISCAL YEAR / V 12 / V 14.1 / V 18 / V 21 / V 25.1 / V 12 / V 15 / V 20 / V 26.1 / V 30 / V24 / V25 / V2 (fHCFA) / V8 (fHCFA) / V26 / V27 / V28 / V29 / V 30 / V 31 / V32
2015 / X
2014 / X / X / X / X
2013 / X / X / X / X / X / X
2012 / X / X / X / X / X / X
2011 / X / X / X / X / X / X
2010 / X / X / X / X / X / X
2009 / X / X / X / X / X / X
2008 / X / X / X / X
2007 / X / X / X / X
2006 / X / X / X / X / X
2005 / X / X / X / X
2004 / X / X / X / X
2003 / X / X / X / X
2002 / X / X / X / X
2001 / X / X / X / X
2000 / X / X / X / X / X
1999 / X / X / X / X / X / X
1998 / X / X / X / X / X / X
1997 / X / X / X / X / X / X
1996 / X / X / X / X / X / X
1995 / X / X / X / X / X / X
1994 / X / X / X / X / X / X
1993 / X / X / X
1992 / X / X / X
1991 / X / X / X / X
1990 / X / X / X / X
1989 / X / X / X
1988 / X / X
AllPatientRefinedGrouper(3M™ APR-DRGs 20.0, 26.1, and 30.0)
The All Patient Refined DRGs (3M APR-DRG) is a severity/risk adjusted classification system that provides a more effective means of adjusting for patient differences. APR-Version 30.0is an update to the previously used APR Version 26.1. Versions 20.0 and 26.1 are provided for use by researchers interested in longitudinal analysis. However, analysis of groupers from previous time periods should be performed cautiously.
CMS-DRG32.0
TheCentersforMedicareandMedicaidServices(CMS)updates its grouper annually, at presentCMS-DRGVersion32.0hasreplaced Version31.0.
Severity of Illness and Risk of Mortality
SeverityofIllness (SOI)andRiskof Mortality(ROM)subclassesrelatetodistinctpatientattributes. SOIrelatestothe extentof physiologicdecompensation or systematiclossof organ function experiencedbythepatient,whileROMrelatesto thelikelihoodofdying. Forexample,apatientwith acutecholecystitisas theonlysecondarydiagnosisisconsidered a majorSOIbutaminorROM.TheSOIismajorsincethereissignificantorgan systemlossoffunctionassociated withacute cholecystitis. However,itisunlikelythattheacute cholecystitisalone will resultin death, thustheROMforthispatientisminor.Ifadditionaldiagnosesarepresent along withtheacutecholecystitis,patientSOIand ROMmayincrease. Forexample,ifperitonitis ispresentalongwiththeacutecholecystitis,thepatientisconsidered anextremeSOIand amajorROM.
SinceSOIand ROMaredistinctpatientattributes,separatesubclassesareassigned toapatient forseverity ofillnessand riskofmortality.Thus,in theAPR-DRGsystem,apatientisassigned four distinctdescriptors for the SOI and for the ROM, numbered sequentiallyfrom 0 to 4.
TheSOI and ROMsubclassdata elements can befound in the HIDD DischargeFile TableSummary[2][i]. CHIA recommends that researchers seeking to evaluate resourceuseor establishing patientcareguidelines use the 3M™APR-DRGsin conjunction withSOIsubclass. Researchers seeking to evaluate patientmortality, should usethe3M™ APR-DRGsin conjunctionwiththeROMsubclass.
Major Diagnostic Category (MDC)
The Major Diagnostic Categories (MDC) is a classification system that parses all principal diagnoses into one of 25 categories primarily for use with DRGs and reimbursement activity. Each category relates to a physical system, disease, or contributing health factor.
CalculatedFields Available For LDS and Government Users
Age LDS (formerly Patient Age)
Ifthedateofbirth and admissiondatearevalid, then CHIA calculates Age LDS in years.
The calculation is as follows:
- If Admission before Birth Day, then Age = Admission Year –Birth Year– 1
- If Admission on/after Birth Day, then Age = Admission Year – Birth Year
- If Admission Year<=Birth Year and MDC=15, then Age=0
- Where AgeLDS is valid and < 90, set AgeLDS = Age;
______
- Where AgeLDS is valid and > 89 and <= 115, set AgeLDS = 999
- Else, where Age is Invalid*, set AgeLDS = null;
*Invalid is defined as missing, negative value or value >115